§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
I beg to move,That this House condemns Her Majesty's Government's disregard for, and lack of understanding of, community care; rejects current policies which seriously damage the capacity of social services departments to enable more of the elderly, disabled and chronically sick to live at home rather in institutions; and calls for action to assist local communities to take more responsibility for those in need, help for voluntary bodies to develop alternative ways of coping with increasing social needs, and an end to curbs on local authorities' ability to provide essential services.The motion is deeply critical of the Government. However, before I move to that criticism I have a personal point for the Minister for Health. The hon. and learned Gentleman spoke earlier this week at the dinner that I and many other hon. Members attended, which was given by the negotiating committee of the Pharmaceutical Society of Great Britain. He revealed then that he was in poor health and suffering from 'flu. I hope that his condition has improved and I say that not just out of the Christian benevolence that always eminates from the alliance Bench, particularly to Conservative Ministers, but also because if the hon. and learned Gentleman's speech is less constructive or not as positive as we would hope, an ill wind will blow from this Bench.
The purpose of this debate, like the one that preceded it, is to be constructive. Ours is the constructive approach. Ours will not be—here I am looking at the empty green Benches elsewhere on the Opposition side of the House —the rather mediocre line of defence that the Labour party presents. However, I am pleased to see that the hon. Member for Oldham, West (Mr. Meacher) is here. I congratulate him on his appointment to the Front Bench and look forward to his contribution.
Our main enemy is the Government and we speak on behalf of the many people who are suffering from an insufferable Government's policies on community care. The Government said in their consultative document "Care in the Community" of 1981:more social services provision is needed, both to keep up with the rising numbers of very elderly people and to provide for those being cared for in hospitals who might be better cared for in the community. Reducing long-stay hospital accommodation without expanding alternative provision is not the answer.How right the Government were. They seemed for once to be talking sense, yet their actions since then, and particularly since the election on 9 June, have proved that they are contradicting the logic of their own argument.
Having provided finance to local authorities through joint funding, the Government are seeking to impose rate capping on many local authorities, and that can only lead to a decline in the support that local authorities can give to voluntary organisations. Having realised that what they said in 1981 in the consultative paper did not match what they were doing, the Government began to change tack. This was exemplified by a letter written on 13 September 1983, which the Secretary of State sent to Councillor David Blunkett, chairman of the social services committee of the Association of Metropolitan Authorities. In it, the Secretary of State said:the effect of the joint finance as it arises in other schemes will inevitably bear more heavily on those authorities who are subject to holdback of grant. I am not convinced that this is necessarily an argument for modifying the calculation of expenditure targets or for exemption of particular items of expenditure from them. 471 The need remains for all local authorities to restrain their expenditure … local authorities must review the totality of their expenditure and adjust their priorities in the light of all circumstances.That shows the hollow frame of mind with which the Government approached this problem. Having said in 1981 thatReducing long-stay hospital accommodation without exanding alternative provision is not the answerthey then told local authorities in September this year that the authorities would have to review their commitments in terms of the overall problems that they raced. We know only too well that the greatest single problem for local authorities is the Ministers. This is placing local authorities in an impossible position. It is from that basis in particular that we should direct our attack on the Government.
Any fool will realise that if local authorities are faced with expenditure cutbacks and with great problems over joint funding, the first of their activities that they will maintain are those for which they have a statutory obligation. In other words, the voluntary organisations will suffer first. The great paradox in which the country has been placed—in region after region—as a result of the Government's measures is that as local authorities have cut their spending on voluntary organisations, so local social and economic pressure on people has increased. As a result, the problems have increased and the voluntary services have been all the more stretched. In other words, a double blow is being dealt to the provision of voluntary and community care and that double blow stems from the Government's policy.
Since the return of the House after the summer recess, the Government, and particularly the Prime Minister, have said much about how fond they are of the American Administration. The twisted logic of the economic policy that they have pursued on this issue over the past two years reflects what the previous American Vice-President once called Mr. Reagan's "voodoo economics". I hope that the Government will take note that there is little hope for voluntary services and community care as long as they continue with these policies.
Personal social services are an important problem. Frankly, the Government have yet adequately to defend—although I am sure that the Minister will try to do so tonight — the publication of July 1983 on health and personal social services expenditure. It shows that local authority personal social services spending in 1982–83, set alongside 1983–84, rises from £2,753 million to £2,973 million, and that the figures for the personal social services total measures are £2,852 million to £2,973 million for the same period. Perhaps that is one reason why the Government say that they are spending more.
Indeed, the Government are spending more in cash terms, but what are they spending in real terms? If one feeds those figures through the standard Treasury statistical technique—a Government technique, I hasten to add — the GDP deflator, one finds that current spending has declined by 3.1 per cent. and that the total personal social services expenditure has declined by 1.3 per cent. In other words, in real terms, there is a decline. With an expanding elderly population and demographic changes, increasing burdens are to be placed on local authorities. I look forward to hearing the Minister's comments on this subject. The matter was raised by my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen) in his speech in the National Health Service 472 debate, and on that occasion it was not adequately answered. So we look forward to an explanation from the Government.
The result, therefore, is a disastrous fall in standards. Of course, the elderly will be among the worst hit. The demographic changes have been well documented, and there is little need for me to repeat them. Age Concern England and many other groups as well as the Government themselves have pointed to the areas of concern. It is clear that in 10 years there will be 4 million people over the age of 75. Twenty years will have seen a growth of 60 per cent. in that age group. People over 75, compared with people between the ages of 16 and 65, are 26 times as much a financial burden on the personal social services. In human terms, it means that housebound, bedfast people will increase by 74,000, those who are unable to bath without physical assistance will increase by 200,000, those who are unable to leave their own homes unassisted will go up by 60,000, and over 250,000 will be living alone.
As a result, there will be an enormous increase in community care. What do we see? We are faced with a decline in Government support for the mechanisms, the local authorities and the provisions that are supposed to provide that community care. That is, surely, deeply distressing. It is little wonder that my right hon. and hon. Friends, and I am sure all hon. Members, hear constant complaints from constituents asking for advice and help in their suffering. I have quoted several statistics tonight, but we must not forget that behind each statistic are human values, human dignity and the right of people to enjoy a better standard of living. I am sure that the Government share our concern, but frankly their actions do not meet their rhetoric, and it is high time that their rhetoric matched the reality.
The Government's approach to local government is increasingly centralist. Investments that are taking place, or have taken place, in voluntary organisations are being put at risk as a result of programmes that the Government are implementing. Surely, voluntary organisations play a crucial role in the provision of community services. I pay tribute to the Government for their increased financial support to voluntary organisations—of that there is no doubt, and we compliment the Government on it—but I repeat—it is the central issue of the motion—that the rate limitation proposals that many district and local authorities fear, or are experiencing, mean that the Government are giving money with one hand and taking it away with the other. That is a hopeless situation in which to conduct business and to seek to improve the quality of services and facilities.
The basic unit of structure in community care is, clearly, the family. The Government have rightly said that they want to increase the role of the family. Since the beginning of time the success of the family has depended on love, compassion, tolerance and mutual respect and understanding. Frankly, the Government's attitude is far removed from any of those ideals. Victorian values—except, perhaps, for the best-off—never displayed those ideals to any great extent towards the people who were suffering. Those suffering people are already under intense pressure, and I hope that tonight the Minister will tell us about some positive action that the Government intend to take to relieve the pressure.
If community care is to be backed up by efficient, effective and fair personal social services, it needs communication and a consensus in society. That is the 473 basis on which the system operates. Communication between central and local Government is appalling. Edicts are sent out and local authorities are expected to comply with them. If they do not do so, they are heavily penalised.
The ideal of consensus comes not only from the Liberal Benches. Hon. Members may have seen the interview with the former Conservative Prime Minister, Mr. Harold Macmillan, who made it clear that in British politics consensus is not an ugly word. The Prime Minister used to call herself one of the conviction politicians, although I notice that she no longer does so. The consensus that any Government should create is not being created by this Government. That consensus is not the hallmark of this Government or of this Prime Minister. Nevertheless, there is a grass roots feeling of social concern in the country. It was illustrated in the excellent series in the early autumn — the LWT "Breadline Britain" series. People are worried about poverty, social hardship and the right to access to social justice, the right to enjoy community care and to benefit from personal social services. What we have had so far from the Government is as inept as it is inadequate.
We in the Liberal-Social Democratic alliance offer this debate tonight in a constructive fashion of opposition. We look forward to hearing the Conservative contributions, and perhaps to more than one contribution from the Labour Benches. In particular, we look forward to the words of the Minister, especially if he can defend or explain the financial implications of community care that we have raised on two occasions in the House. The Government must realise that they are the Government of the nation, not just of the diminished number of people who sent them back to office. To do that, the Government should display a greater social consciousness and social concern. They can do that through the reality of their policies and through the rhetoric of their politicians. At the moment both are deficient. It is in that constructive sense that we have tabled the motion, and we look forward to hearing the Government's defence of their policies from the Minister.
§ Mr. Deputy Speaker (Mr. Paul Dean)
Order. Mr. Speaker has selected the amendment in the name of the Prime Minister.
§ The Minister for Health (Mr. Kenneth Clarke)
I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:`recognising the constraints imposed by the needs of the national economy, applauds the Government's initiative in promoting new policies for personal social services as set out in "Care in the Community" including new measures to ensure that more of the elderly, mentally ill and mentally handicapped are enabled to be cared for at or near their own homes rather than in institutions; welcomes the Government's action in improving and extending the Joint Finance Scheme, improving co-operation between statutory services and voluntary groups and increasing financial support for the voluntary sector; and looks forward to a continuing steady improvement in the level and quality of support available to those in need in the community.'.I should like first to congratulate the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) on the manner in which he delivered his speech. Although it was not a maiden speech it must be the first time he has introduced a motion for a half-day debate. He did so with considerable 474 eloquence, fluency and, for most of the time, factual accuracy. The hon. Gentleman succeeded before he had even started in drawing a larger number of Liberal and Social Democrat Members into the Chamber than I can ever recall seeing before. I am sure that it is not the hon. Gentleman's fault but he seemed to drive away all Labour Members bar three before he even started. He gave his colleagues an opportunity to hear, for the first time in some cases, the SDP policy on personal social services, which the party was unable to debate at this year's conference. As the hon. Member for Liverpool, Mossley Hill (Mr. Alton), who is to reply, is a well-known critic of the alliance with the Social Democrats, he will no doubt put a different gloss on alliance policies. Conservative Members will listen with interest to get an inkling of the differences that still divide them.
Perhaps it followed from the hon. Gentleman's remarks on consensus politics, but as I listened to his speech, I found that the Government were being pursued for policy objectives on which there is not a great difference between us. The objectives that the hon. Gentleman put forward on behalf of his party were a pale shadow of the Government's objectives. Worthwhile objectives for looking after those in need in society are ones which Governments of any complexion try to pursue. There are some areas in which I think the Government are clearer on how to achieve those ends, but we are very much on the same wavelength on objectives.
We accept that the demand for personal social services and support in the community for those in need will grow in the next few years. The number of elderly people in our society will rise. I accept the hon. Gentleman's figures. We also have a changing pattern of care for the mentally ill, the mentally handicapped and the chronically sick, and we look forward to supporting more of them in the community than in institutions. The rising demand is caused by demography and the changing pattern of care.
I agree with the hon. Gentleman that this means that the statutory bodies—the local authorities and the health authorities — must respond to those rising demands. They must also take the lead in society and bring out of society itself all the voluntary efforts of friends, relatives, neighbours and those who have joined organised voluntary groups and are prepared to play their part in supporting those in need in our midst. There is an area of growing need to which we must respond. We must also respond to the changing pattern of demand in different ways. We must ensure not only that the statutory services play their part but that we give a lead to the whole community in drawing on the good will of the many individuals who want to help.
In this area the Government have produced new ideas, new money and well-directed initiatives to improve the pattern of social care as well as support for the more familiar forms of social care, which are obviously well worth supporting. Apart from our particular support for the narrow policy area, we have introduced a policy which we apply to every part of public sector activity. We are concerned with the effectiveness of what we do and the quality of the work being done. We are concerned with raising the standards of professional practice and the social work carried out. We think that efficiency, cost-effectiveness and elimination of waste are ways of maximising the worthwile end product for the client, the patient or whoever it may be.
475 I should first like to give the House the background on finance and money. Our critics in all parties are obsessed with the money and the statistics of the amount spent in every area of activity. We must put the hon. Gentleman's criticisms and the others that will follow into perspective by considering what has happened to local authority personal social services expenditure during the Government's period of office. The amount spent by local authorities on social services has doubled in cash terms. In 1978–79 the figure was £1,062 million; in 1983–84 the budget is for £2,159 million. The conventions that are usually used to try to work out how much growth in services this represents after allowing for the pay and price increases experienced by local authorities show a growth in services of about 12.5 per cent. over the five-year period. The increase in spending during this time, applying the measures that are usually used when cost is being calculated — how the cash compares with movements in the retail price index during the same period — has been 19–9 per cent. compared with the retail price index. Measuring these things in cash, money or amount spent is not good enough but that is the basis of the criticism offered. The criticisms about our cutting the service to the bone must be set in the context of an increase in spending of about 20 per cent. compared with the RPI.
§ Mr. Donald Anderson (Swansea, East)
If the Minister compares those two sets of figures with the rising tide of demand, he will be driven reluctantly to the conclusion that it represents a standstill.
§ Mr. Clarke
I do not think that that can be supported. We will hear during the debate the various estimates of what the rising tide of demand amounts to. Demographic change alone probably accounts for about 1 per cent. a year. With 12 per cent. over five years we are ahead of demographic demand. Therefore in cash terms alone, resources are being expended by local authority social services departments which allow for real growth and the development of services.
I accept that the pattern of spending and activity in each local authority varies. The figures I have given are national. The hon. Gentleman and other hon. Members will set those figures against the background of the Government's general policy on local government spending and our urging on local government a restraint in spending of the type we have had to exercise during a period of economic recession. How do the best local authorities achieve the expansion and development of their services against the background of our policies, which the hon. Gentleman suggested would damage local authorities shortly if they have not done so already? We have asked local authorities to make sound judgments on the priorities within their budgets between services and within services. Of course we have asked them to protect services for the vulnerable. We have asked them to develop services for the priority groups.
That is consistent with the Government's policy towards local authority spending in that it must accompany the elimination of wasteful and unnecessary expenditure in which many local authorities indulge. That means that even within the social services departments themselves there is scope for improving efficiency and cost-effectiveness. That must be so in an area which consumes £2 billion each year and employs more than 200,000 people. Throughout all local authority activities, cutting 476 out the wasteful and the unnecessary is a way of producing money that enables us to pursue priorities in social services, education and so on. That is the Government's policy and it is consistent with care and concern for the underprivileged who depend on local government services.
§ Mr. Kennedy
Even accepting hypothetically the Minister's premise, and if wastage, unnecessary expenditure and bureaucracy were eliminated. is he seriously suggesting that the savings generated in local authorities by that exercise would be enough under the Government's rate capping proposals to replace, maintain and continue to extend in pace with demographic changes, particularly with regard to the elderly, the joint financing programmes which they have supported in the past? Is the Minister suggesting that it can be balanced?
§ Mr. Clarke
Our policy is just that. We are putting forward policies for restraint of Government spending in all areas of local government activity —the best local authorities can show that it is possible—and saying that it is possible by pursuing the right policies and doing things efficiently and effectively to carry on providing worth- while services in this area. I will not bore the House with examples of the frivolous expenditure in which many councils still indulge in some of their activities, and then get into penalty, such as rate capping.
The Government do not impose penalties on individual aspects of local government expenditure. Councils get into penalty on the totality of their expenditure, and those that incur the misfortune of finding their rates capped are those that have got into penalty on the totality of their expenditure.
Councils which then say to their ratepayers, "Because we are in penalty we must halve our home help service or close down this or that popular day centre for the disabled," or whatever it may be—I have no specific examples in mind; one must look at each case on its merits —are playing politics. That is my first reaction, because a council that is spending so much as to be achieving penalties is making a meal of it if it parades a local popular service to the public and says that Government penalties mean that it must be cut out.
§ Mr. Clarke
I shall be in danger of cutting some Liberals and Social Democrats out of the debate if I keep giving way.
§ Mr. Stephen Ross
I invite the Minister to come to the Isle of Wight — [Interruption.] at my expense, tomorrow, next week or at any time—to go through the very matters about which he has been talking. The problem that local authorities have is how on earth they can stay within the limit without going into penalty. It means cutting home helps and shutting village schools. They are some of the terrible choices that have to be made, and I beg the Minister to come to my constituency one clay to sort out some of those matters.
§ Mr. Clarke
Spoken like the Liberal leader of a county council. I will take up the hon. Gentleman's invitation gladly if a suitable opportunity presents itself. Many councils throughout the country are not incurring penalties and do not find that they must take such dramatic action vis-a-vis their social services.
477 That is the position on money, but it is not just a question of money. It is the Government's case that one cannot measure activity in this or in any other area just by arguing about the statistics of what is actually spent, particularly in an area like the personal social services. Those really interested in the subject must look not only at the cost of what we do but the value of what we do for those groups most in need. Local and central Government must, and do, share a common interest in improving the effectiveness of the service — getting better value for money, making it more cost-effective, introducing more good practice and spreading the best of professional practice as methods change throughout the country.
That is an area at which we have been looking, following the Barclay report on the work of social workers. We have been looking at ways of co-operating with local government and helping to spread good practice, keeping up standards and improving the effectiveness of what is done. I have been discussing our proposals with the local authority associations, and much remains to be done. We have it in mind to set up a social services inspectorate of the kind suggested in the Barclay report.
Our proposal is that it should be based on the existing DHSS social work service, which has an excellent reputation in the field for its professional standards, and that, in addition to those people, we should second good leading social workers from local authority work, probably some lay people with suitable professional and other skills that they could bring to the work from outside.
It would be a new inspectorate that would carry out most of the statutory inspections for the Secretary of State, as of now — indeed, the local authorities urged us to carry out more statutory inspections—and we hope to agree with the local authority associations a wider range of inspections, some covering one authority, and others covering several authorities, in agreed areas of concern. Those inspections would provide a number of functions.
I emphasised that we are working up the idea in the course of helpful discussions with the local authority associations. We hope to produce a body that will carry out inspections, so doing work of a kind that I see as a sort of cross between the HMIs in education, the probation inspectorate perhaps, and, above all, the health advisory service, the work of which is of considerable use to health authorities in the National Health Service. We must have a body that is satisfactory to everybody and is designed particularly for the social services sphere.
It would retain the present functions in the social work service, commenting on the standards of service and quality of care, but also providing advice, information and assessments aimed in the first instance at the local authority itself. I trust that it would help the members of local authorities, particularly the social services committees, in their task, which is to evaluate their service, keep up standards there and help formulate policy in the light of outside advice.
I have time to give only that one example, but it is one way in which the Government are trying to involve themselves in a way that will be of assistance to all those in social work activities. We hope to make sure not only that we wrangle about how much money we spend, or how much grant the Government provide and whether it is right that authorities may get into penalty—I have given the 478 figures showing by how much expenditure has expanded during the years we have been in office—but that we also look at the value we are getting for the money that is going in. The new inspectorate will be one way in which the Government can help local authorities raise that value.
§ Mr. Anderson
Will the new inspectorate, with the new civil servants who will be employed, be empowered to point out deficiencies in the quality of provision in individual local authorities, and might that lead to greater expenditure in those cases to catch up with the average or better local authorities?
§ Mr. Clarke
We shall not be employing new civil servants. I am sure that the hon. Gentleman will guard against the tendency to believe that new ideas must create the employment of more publicly employed people to run them. We have about 100 social workers in the social work service already and we are not looking to add greatly to that number.
I also urge the hon. Gentleman not to take a negative view about the new policy. I understand his wariness. Naturally, we shall ask those concerned to point out deficiencies in services where they find them, pointing them out in a way that is helpful to the local authority, ourselves and the public, in whatever public documents emerge, so that whatever is appropriate to remedy that deficiency can be identified and, we hope, put right.
I have explained one of the ways in which we are concerned with the quality of care, and I come now to the view of the Government on the subject matter, the content of policies particularly in the areas mentioned by the hon. Member for Ross, Cromarty and Skye. His party's motion has some cheek in lecturing us on the need to provide for the care of the elderly, chronically sick and others at or near their own homes rather than in hospital, because that is very much the policy of the Government. The document that he cited as a model to be aimed at was the Government's "Care in the Community" document published in 1981, and we have an excellent record.
We inherited the system of joint finance. As an example of Government support of community care, it is health authority money expended for community care and it is in support of our general objectives. It is a good system and we have built on it. In the year before we took office, 1978–79, the joint finance allocation was £34.5 million. In the current year the allocation is £94.1 million, an increase of 180 per cent. in cash terms and 50 per cent. in real terms. Total NHS expenditure on joint finance schemes up to last March amounted to over £300 million, a significant sum by any standards.
The take-up remains high. The hon. Member for Ross, Cromarty and Skye said what is repeatedly said by those in local government—that in the end, when the taper is operated, the burden falls on local government and is a discouragement to them. But it has always been in the rules of the scheme that eventually the burden will fall on local government so as to release the joint finance pool for new developments.
As I said, the take-up of joint finance remains high. The £300 million to which I referred is about 95 per cent. of the total to be allocated, and the indications are that the whole of the joint finance allocation for this financial year will be taken up, so some authorities are being deterred more than others. As the hon. Gentleman said, those being deterred the most are those that run the risk of penalty. The 479 Government say to those authorities in reply, "Do something about your total expenditure. Get rid of the nonsense you are spending money on now and you will not be in such risk of incurring penalties, and then you will be able to take advantage of the joint finance to the same extent as others who are taking it up."
The "Care in the Community" initiative took matters beyond joint finance. It was designed expressly to deal with the problem of, for example, long-stay patients who needed to be moved out of hospital so as to have more suitable support in or near their own homes. We have just launched that scheme. Part of it depends on an extension of the joint finance arrangements so that joint finance can now be used for up to 10 years at 100 per cent. of support costs and up to 13 years in all in the "Care in the Community" circumstances.
After that time the health authority can use its own money for an unlimited period to support the cost of community care for those who would otherwise be unwilling long-stay patients in hospital. To help promote the intitiative the Government are setting up a programme of pilot projects. We have set aside £15 million of joint finance for central support. We have already had 50 outline applications and I hope that that programme will go well.
We have tried to involve the voluntary sector as well as the statutory sector to provide community care for people who might otherwise be hospital patients. We are encouraging health and local authorities to co-operate more closely with each other and to draw the voluntary organisations into joint planning concerns. We have given voluntary organisations a place on the joint consultative committees of health and local authorities.
§ Mr. Michael Meacher (Oldham, West)
The Minister slides rather too glibly over joint funding, as he does on so many matters. He suggests that local authorities were aware of the effect of tapering arrangements on revenue expenditure. That is true, but they had no inkling that the Government would impose rate capping on them. That has now happened and has combined with the effect of the tapering arrangements. If the Minister will not disregard this expenditure for the purpose of calculating targets, will he at least consider doing so for the purpose of calculating liability for grant holdback?
§ Mr. Clarke
We have had such representations ever since the scheme started, and we are continuing to look at them. It is highly unlikely that, after the end of the tapering period, finance should be disregarded. Once such exceptions are made, the basis upon which it is necessary to control Government expenditure is destroyed. It is surprising that local authorities insist that the threat of targets makes them turn to some community care projects at an early stage when they are looking for savings.
Let me illustrate the new ideas that the Government have introduced alongside the greatly increased expenditure that is taking place. We keep announcing special initiatives which are Government financed and normally intended to pump prime in important areas. Announcements have been made about services for mental illness in old age. That initiative was launched when the health advisory report "Rising Tide" was published earlier this year. Over the next three years £6 million will be made available for that and I am glad to say that the regional health authorities have now nominated the districts where 480 new comprehensive services for the elderly and mentally ill are being launched. I hope that all those districts which devised schemes to bid for money will not waste the work but will go ahead and, having identified problems in the area, will try to develop services.
We have attached high priority to taking mentally handicapped children out of hospital. We launched our initiative at the end of 1980 and since that time authorities have been encouraged to review the needs of all children in their care. We are pleased that so far we have been able to provide central funds to help launch 19 local schemes for transferring children from long-stay hospitals to community care. We hope to be able to support similar schemes in the near future. We have had 70 applications for funds under that scheme which shows that authorities throughout Britain share our concern that young mentally handicapped children should not have long-stay care in hospital but should be in smaller units.
I remind the House of our initiative on young offenders. We are making sure that vulnerable young people in trouble with the course who can benefit from non-costodial treatment are given some positive help outside borstal and detention centres. We have a new community -based package financed with £15 million spread over the next five years to build up a new system of so-called intermediate treatment. That is a phrase we all hate but no one has thought of a better name. We hope that that intermediate treatment will command the confidence of magistrates and the public and provide a more constructive way to deal with young offenders.
We are also making progress in implementing the Children Act 1975, which should be popular in this debate as the leader of the Social Democratic party was responsible for its enactment. Until now it has not been possible to put all its provisions into effect. My hon. Friend the Under-Secretary of State for Health and Social Security takes the lead on this matter and he is steadily bringing the provisions of the Children Act into effect and also making other improvements in child care and access to children.
§ Mr. Kennedy
I am glad that the Minister mentioned my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen). Will the Minister be considering the wide issue of custodianship as part of those developments?
§ Mr. Clarke
Certainly, and perhaps I shall be able to help the hon. Gentleman on that.
We have made considerable strides. On the adoption side we have introduced three important measures —arrangements for approval by the Secretary of State of voluntary adoption societies; the ending of private adoption arrangements and the introduction of adoption allowance schemes. In April 1984 we shall bring in provisions which will enable courts to declare a child free for adoption and several smaller improvements to adoption procedures. We shall then have gone a considerable way towards completing implementation of the Act's adoption provisions.
A major part of the 1975 Act is custodianship—sections 33 to 46—on which the hon. Gentleman has just prompted me. The difficulty of finding extra resources for the courts has stood in the way of earlier implementation under successive Governments. However, I am glad to say that with the agreement of my noble 481 Friend the Lord Chancellor—it is his budget that has to provide the resources — we shall be introducing custodianship provisions by the end of next year. That will mean new opportunities for security and stability for children for whom adoption would not be the right solution, including many children in long-term care.
On the care side, our priority has been the full implementation of section 64 so that parents can obtain legal aid in care proceedings in all cases where the court has asked that they should be separately represented. At the same time courts will be able to appoint guardians ad litem. We are bringing in that part of section 58 of the original Act which is now section 7 of the Child Care Act 1980 which will enable courts to make the child party to proceedings and to appoint guardians ad litem for children. At present the child has no status in the proceedings before the court.
All those reforms will come into force in April 1984 and we shall be able at last to see the proceedings operate as the 1975 Act intended. We have recently completed a consultation exercise on the setting up of panels of guardians ad litem. The 1975 Act provides new functions for guardians ad litem in care proceedings and parental rights proceedings. They will also have a role in the new access legislation which is still to be introduced.
The consultations generated a widepread and helpful debate on the role and functions of guardians. There is plainly a divergence of views and it has become clear that we need more time to be sure that we have those right.
The procedural guidance contained in the court rules which were drawn up in 1976 is clearly not adequate for the new part that guardians must play in the various proceedings. We have therefore decided to consult more widely than usual on the content of the rules. One effect of this further period of consultation will be that the courts will not be able to appoint guardians if we keep to January for the new access proceedings, as we had intended. However, we have concluded that the new provisions in section 12(a) to (g) of the Child Care Act 1980, as amended, are so important that we should not delay their implementation, which will for the first time give parents the right to challenge decisions by local authorities to deny all further access to a child in care. At the same time, it is essential that the child's interests should be safeguarded.
Although courts will not be able to appoint a guardian, they will be able to make a child party to the proceedings. He will then be entitled to be legally aided and legally represented. This package has enabled my hon. Friend the Under-Secretary of State to keep us to the January date, and a commencement order will be laid in due course. From April, guardians will be available, as intended by the legislation, in access as in other proceedings.
These legislative reforms do not represent all that we have tried to do to improve services for children. We have recently completed the consultation exercise on the new code of practice on access to children in care, and guidance on procedures for the assumption of parental rights. We were very encouraged by the response to the consultation, and we hope that the documents will do much to encourage the good practice that is an essential complement to enlightened legislation.
There is no room for complacency. Concern is constantly expressed in the House about the problems of children in care, and about many aspects of the legislation. 482 That is why we are pleased that the Social Services Select Committee last year began an inquiry into children in care. The general election prevented the Committee from issuing a report, but it may be that the newly appointed Committee will be deciding whether to issue a report. If the Committee decides to do so, the Government will welcome that decision. In the meantime, we know that our reforms do not go as far as some hon. Members and some groups outside the House would have wished. However, I believe that we can show — this illustrates the Government's concern in this field — that we have achieved through these measures a material and significant contribution to the welfare and rights of children separated from their parents, and of those children's families.
The smooth working of the developments that I have announced will depend greatly on the ability of the local authorities to absorb them into the working of their child care services. In particular, the local authorities will have a new function of setting up and managing the panel of guardians from next April. We are grateful to the local authorities for the way in which they have participated so far in the formulation of these policies and adapted themselves to the needs of these new policies. I am sure that they will continue to build on this evolving legislative framework to develop their own services.
That concludes my lengthy statement on our position on child care. I have also briefly covered a number of other aspects of social services provision. I hope that I have shown that, lying behind our argument about the figures there is an extremely good record on financial provision. We will continue to listen to arguments about cuts, but at times it becomes pretty daft to tell us that we are cutting financial provision to an area of service where such rapid increases in expenditure can be shown by many social services departments. Apart from the arguments about money, the Government have ideas and concern. They have developed and improved the services for the many who are needy in the community and who need the services. That will continue to be our approach to these matters. I therefore commend to the House the reasoned amendment in the name of my right hon. Friends.
§ Mr. Donald Anderson (Swansea, East)
I start with the simple proposition that a society's attitude to the mentally and physically sick, the aged and the young, and the financial sacrifices that a society is prepared to make for those unproductive people, is one of the key indicators of the degree of civilisation of that society. Judged against that standard, Britain has become a less civilised society over the years of Conservative government. The theme has been cuts in public expenditure and the reduction of taxation. The effect has been increasing misery among those in need and the expansion of a two-tier society, illustrated graphically by the question posed by my hon. Friend the Member for Knowsley, North (Mr. Kilroy-Silk) to the Prime Minister earlier this week. He asked her why, if the National Health Service was safe in her hands, the right hon. Lady was not prepared to feel safe in the hands of the National Health Service.
How different it would be if, instead of the constant theme of public expenditure cuts and reducing taxation, the Government's theme was a crusade to mobilise society to help the needy in our midst. The cuts—or efficiency savings, as they are now euphemistically termed—harm that section of society which is least likely to benefit from 483 cuts in taxation. The Government are totally out of touch with public opinion if they assume that their priorities in this area reflect those of the country as a whole. In both the National Health Service and the personal social services, there are forces for inescapable growth of expenditure. However, the budgets—even on the figures outlined by the Minister—show that there is a standstill, and effectively mean a reduction in standards.
The House held a debate on the National Health Service on 27 October. This debate is its counterpart. The way in which we criticised in that debate the effects of NHS cuts —on bone marrow transplants, on kidney patients and ward closures—have been more than confirmed by the statement yesterday from the president of the Royal College of Nursing. She said that the publicmust face the prospect of a continuously deteriorating health service unless the Government rethinks its manpower and cash cuts policy for the National Health Service.Despite the Minister's excellent advocacy, that is the reaction of someone in the front line in the real world.
Of course there is an interaction between the NHS and the personal social services. The financial pressures fall on both. That interaction is clearly shown by the continuum of housing for the elderly, through sheltered and residential home to hospitals. The director of social services in west Glamorgan, for example, would certainly dispute the average figure that the Minister gave for the percentage increase needed annually to remain at a standstill. He states that in our county we need at least a 2.5 per cent. increase in expenditure on the elderly if we are to maintain standards.
Thus, there is pressure at each end of the housing continuum as a result of Government tits. Obviously, housing as a whole has suffered the greatest proportion of Government cuts during the past five years. Equally, as a result of cuts in social service budgets, the building of residential homes for the aged has been postponed. In my local authority the average age at which a person is admitted to a residential home for the elderly has risen to 80. Obviously, those homes are becoming quasi-geriatric hostels. As people at that more advanced age are more frail, there is a corresponding effect on staff ratios and on the need for more paramedical assistance.
The Minister's reply has been that local authorities must look at their own housekeeping and that they are profligate. However, I invite him to consider the record of my local authority, west Glamorgan, and to see where he thinks those cuts should be made. Cuts also have implications for those local authorities that sponsor beds in voluntary homes. There has been an increase in the number of private homes for the elderly, which has been encouraged in turn by the increased board and lodging allowances of the DHSS. In principle, there is nothing wrong with that, as it means that the elderly have more choice. however, as residents become more confused, voluntary homes frequently do not want to know, and pass the problem on to the statutory authorities that have an obligation to provide.
The Government's response to the increasing demographic pressures in our society includes continued progress in community care. I welcome the Government's initiatives in that respect, and the important announcement concerning legal representation for children that the Minister outlined. Those changes are admirable. For example, my local authority is one of those pioneers developing community programmes for foster care. That 484 has led to a decrease in the number of children in residential care. It is cost effective, and releases resources for expenditure on the elderly. Similarly, my county has developed community care for the elderly, with intensive home care, which is encouraged by the Government. It has employed 66 extra people in the process as robots cannot be used to tackle the problem of more intensive home care. By so doing, the local authority has faced the problem of manpower restrictions imposed by the Government. If the Government glibly ask why the authority does not cut manpower in other areas of the social services, the authority would reply by saying that manpower in the social services has already been trimmed by 17 per cent. in the past two years so it is difficult to provide the additional resources needed for intensive home care from within the existing manpower of the local authority social services department. The Government in this as in other areas must consider the manpower implications of their policy.
The Government have responded to criticisms by saying that we should develop voluntary care within society. We welcome the increased financial assistance available for voluntary organisations. History shows that when voluntary organisations have pioneered developments and shown the way, the state thereafter assumes responsibility.
Strict limits are imposed on what voluntary organisations can do because of the need for consistency in the long term, because of the scale of the required operation. Although further progress can be made, the Government may be encouraging unrealistic expectations of the progress which can be made by expanding the voluntary sector.
Problems have occurred in the joint financing schemes—the tight financial targets and the tapering arrangements which many local authorities say have deterred them from embarking on worthwhile schemes. We must have clear, and permanent joint arrangements to gain the confidence of local authorities.
Can a service subjected to severe expenditure cuts cope with increased demographic and other demands imposed upon it? My right hon. Friend the Member for Bolton, South-East (Mr. Young) has already referred to the rate-capping system—perhaps better described as Whitehall's knee-capping operation on local authorities.
If we wish to continue the growth of the community services for the elderly, we must consider whether we have abandoned the family and community structures which are necessary for the success of the operation.
Will the Government consider good neighbour schemes such as those pioneered in some parts of the United States — although the individuals who participate in the scheme must be carefully vetted? The scheme is needed at a time when, because of increased mobility, families are dispersed and individuals in the community are needed to assist the elderly and the handicapped by visiting them, shopping and reading to them. Such a scheme might make an inroad into the army of unemployed. The Government could encourage such a scheme by re-examining the rules of income in terms of unemployment benefit. People can participate in a proper community service activity without suffering the poor law implications which can be ascribed to it.
We could increase community care and mobilise some of the unemployed in our community with assistance through the benefit scheme, thereby enabling people to 485 live longer in their communities and be less liable to be institutionalised and giving much-needed work, identity, a role and above all dignity to the growing army of unemployed in our society.
§ Mr. Timothy Yeo (Suffolk, South)
I begin my contribution to this important debate by expressing strong support for Government policy in this area. I especially commend the consultative document, "Care in the Community". Publication of that document was a great step forward. It showed the Government's willingness to act where many of their predecessors had merely spoken. I am sorry that that has not been more clearly recognised by the Opposition. I listened in vain for the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) to say anything constructive other than endorsing existing Government policy.
"Care in the Community" was widely welcomed by the professionals and by voluntary organisations, including the Spastics Society. I shall refer to three aspects of that document. First, joint finance is being extended to cover housing and education. That is especially welcome. The elderly, the mentally handicapped and the mentally ill should not always be considered in terms of social service provision. The perpetuation of a medical and social service model for the care of those groups is unforunate, because they have other needs, especially in housing and education. In addition, as my hon. and learned Friend the Minister for Health has said, £15 million is to be top sliced from the joint finance allocation to be used for a range of innovative and pilot projects. Innovation is essential. If we are to rehabilitate people into the community, we must be imaginative in the way in which we tackle the problems.
Secondly, in relation to mentally handicapped children in long-stay hospitals, I warmly endorse the statement by my right hon. Friend the Secretary of State for the Environment when he was Secretary of State for Social Services. He said:The time has come to state unequivocally that large hospitals do not provide a favourable environment for a mentally handicapped child to grow up in.That statement was made three years ago. Since then a £1 million matching funds scheme has been set up, designed to encourage voluntary organisations to set up schemes to bring children out of long-stay hospitals. That was a further demonstration of the Government's determination to make progress with this problem. The Spastics Society has been promised £250,000 from the DHSS to establish a unit in the north-west to rehabilitate into the community children with multiple handicaps and severe behavioural problems. I hope that the Government will consider extending the pound-for-pound matching funds scheme and increasing the amount of money available so that more projects can be funded. A further £3 million from central funds is also available for health authorities with special problems to develop schemes to get children out of hospital.
Thirdly, the work of the voluntary organisations is close to my heart. They have traditionally provided community services for the elderly and the handicapped. They have supported those people in the community. Their services are an essential supplement to the work of the statutory authorities. They are often specialist. In relation to 486 handicapped people especially, an organisation dealing with a particular category of people can often provide specialist assistance which local authorities sometimes cannot provide. The service is often good value, too, because of the voluntary input. I therefore especially welcome the inclusion of these bodies on joint consultative committees. I know how valuable participation in the planning process will be to them.
Not everything in the garden is as perfect as we would like. There are many worries. For example, can health authorities, with ever-decreasing budgets, maintain hospital services and at the same time develop community services? The present method of administering joint finance gives local authorities less incentive than I should like them to have to develop community services, although the high rate of take-up, referred to by my hon. and learned Friend the Minister for Health, is encouraging. I hope that it will continue.
Another worry is whether adequate resources are being allocated to get children out of hospitals. It would be highly desirable to set a date by which all children would be out of long-stay institutions for the mentally handicapped. The establishment of such a date would concentrate wonderfully the minds of the regional health authorities' administrators. I am not satisfied that regional health authorities are making enough progress in that direction. In addition to setting a date, if the numbers of children remaining in long-stay institutions were published regularly, that would help to focus regular public and political attention on the problem.
I stress the importance of providing support for those who do the caring in the community. [HON. MEMBERS: "Hear, hear."] I am glad of hon. Members' support. I still attach great importance, when resources permit, to the extension of the invalid care allowance to married and cohabiting women. At present there is discrimination against them which should be ended as soon as resources permit.
More directly relevant to the personal social services is the need for adequate and nationwide provision of short-term respite care. That would allow families the chance to have a break from the work which most of them do with great commitment and pleasure for their handicapped or elderly relatives. It is essential that those families have opportunities for a break from the burden of caring and that the respite care is undertaken locally rather than hundreds of miles away.
The Government's recognition of that problem was welcomed last year when they decided to save Tadworth Court children's hospital. It provides just such a service for many families with handicapped children who are in desperate need of a break. That was an imaginative and tangible demonstration of the Government's willingness to adopt an unusual scheme to preserve a valuable service on a cost-effective basis. I hope that that decision, and the transfer of Tadworth to the group of voluntary organisations which hope to take over the administration, will be accomplished very speedily.
I shall set an example and make my contribution brief. Everyone recognises the importance of personal social services in relation to community care, and acknowledges the growing size of the problem. Many hon. Members will undoubtedly have had the statistics kindly provided by, among others, Age Concern. Thankfully, the Government are facing the issues and tackling them positively and imaginatively. As my hon. and learned Friend the Minister 487 said, the resources devoted to community care have substantially increased under the Government. For that reason, I hope that the House will reject the motion and pass the amendment.
§ Mr. Deputy Speaker
Order. The House might like to be informed that the winding-up speeches are expected to begin at about 9.30 pm. Several hon. Members hope to speak before that.
§ Mr. Michael Meacher (Oldham, West)
I congratulate the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) on his speech. Like the Minister, I thought that he spoke with great fluency and much feeling and consideration for the subject. I congratulate him on his choice of subject.
I am afraid that I can find no such ready words of praise for the Minister's speech. No doubt he will not be surprised. Although he delivered his speech extremely fluently, as he always does, it was the most extraordinary self-righteous tour de force that I have heard for a long time, even from him. He gave the impression that it was all a matter of avoiding waste or of administrative cost-cutting. There was not a word about rate-capping, cuts or a massive grant holdback.
We in the Opposition share the view of the hon. Member for Suffolk, South (Mr. Yeo) that we should like all children to be transferred out of long-stay institutions by a given date. However, there is no use suggesting such policies and voting down the line in support of economic policies that make that impossible.
If the Minister is really concerned about making cuts, I recommend him to look to the places where cuts can be made. I give two examples. First, the drug companies take advantage of the National Health Service. The second example is defence contractors. The Minister could make bigger savings in those areas rather than battening on some of the weakest and neediest in our society.
I welcome the debate, as it rightly draws attention not only to some of the poorest and most vulnerable people in our society, caught in the vice of the Government's increasing squeeze on local authority spending, but—this is just as important—to the false economies that a policy of blind and obsessional cutting produces in the key area of personal social services. Improving community care should be the flagship of a caring society. Under the Government it has become the victim of accounting criteria that not only are damaging or short-sighted but, if present policies are not reversed, will lead to gross mismanagement of the nation's resources. I shall explain why.
The Minister has made a great deal of the 9 per cent. real growth in personal social services in the four years up to 1982–83. Perhaps it is now 12 per cent. The Minister mentioned that figure today, but perhaps that is over a five-year period.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)
It is 12.7 per cent.
§ Mr. Meacher
Perhaps it is 12.7 per cent. The Ministershould not get so excited. If he listens to what I shall say,he will hear that the Government's record is not attractive.
There are two good reasons for regarding the growth rate as far from a triumph, which is the way in which the 488 Minister for Health seeks to represent it, but as distinctly unsatisfactory. One is that it is a fairly paltry record of growth when it is compared with what went beforehand. As I am sure the Minister knows, between 1969 and 1979, which I admit is a longer period, expenditure on personal social services went up by no less than 150 per cent in real terms. Therefore, when the 9 per cent. is put in perspective, it is a pretty poor falling off. This year there will almost certainly be a cut back in real term. Over the whole five-year period, there is no doubt that the Government have totally failed to expand the personal social services to the extent necessary for them to perform their real role as a major and complementary partner of the NHS.
There is a second, more serious reason why the 9 per cent. or 12 per cent. —or even 12.7 per cent.—is an alarming shortfall. It is insufficient even to keep up with the increasing number of elderly people who need the services. I entirely support what my hon. Friend the Member for Swansea, East (Mr. Anderson) said about the comparison with demand. That is the bench-mark by which we should judge performance in personal social services.
The Minister has all too often resorted to using the wrong criteria. It is not growth in real expenditure per se that is the real measure, but improvement in a constant level of service that takes account of extra demand. By that criterion, the Tory record over the past five years has been lamentably deficient in community care programmes. The Government's measure of a constant level of service is a 2 per cent. real expenditure increase per year The Minister said 1 per cent. I am not sure whether that was a slip.
§ Mr. Meacher
The Minister said there was a demographic 1 per cent. increase, but the figure which the DHSS has used repeatedly is 2 per cent. Even the DHSS does not believe that 2 per cent. additional growth per year is enough to meet the extra demand. In a written answer on 15 February the hon. Member for Braintree (Mr. Newton) said:central Government concluded last year that a minimum"—that is the word I stress—expenditure growth of two per cent. was needed to maintain existing standards of service in the face of growing numbers of the very elderly and other increasing pressures." — [Official Report, 15 February 1983; Vol, 37, c. 135.]There is irrefutable evidence that 2 per cent. is far too low. I suspect that many officials, if Ministers were to press them, would admit that.
To give one example, in 1980–81, when Government figures were registering real expenditure growth well in excess of the 2 per cent. demographic allowance, we now know from surveys that there were widespread cuts in service. In fact, 13 out of 18 areas of service suffered reductions in absolute levels of output at the same time as the Government tell us that there were real expenditure increases of 2.75 per cent.
The Association of Directors of Social Services in its latest report, of which the Minister will be aware, says that in its view 4 per cent. or even 6 per cent. real growth is required simply.to prevent standards from dropping".That is a very important statement coming, as it does, from that association. I am well aware that the Minister replied 489 to that statement when it was made and I have read in detail what he said, but I still believe that the association is probably nearer the truth than he is, for two reasons.
One reason is rising unit costs. This is no fault of the Minister but he must take account of it and he is not doing so. For example, the Disability Alliance recently concluded that rising unit costs meant that 5 per cent. real expenditure growth purchased less than a 1 per cent. increase in services. I hope I have the Minister's attention because I think he has not taken account of the significance of that. It indicates that there are sharply rising unit costs and that a 2 per cent. increase in resources over and above inflation is completely insufficient to take account of extra demand and extra need.
The other reason is that under the Government's regime the level of services has nowhere near kept pace with the growing number of the over-75s. We are all agreed on the figures. I shall give one simple measure of this.
§ Mr. Meacher
I shall give way when I have given this example. In round terms there was a 10 per cent. reduction in residential places, home helps and meals on wheels per 1,000 population of the over-75s in 1980–81 compared with five years earlier; that is the real criterion. That was after two years in which the Government figures were allegedly registering real expenditure growtn of 4.5 per cent. and 2.5 per cent.
§ Mr. Patten
As the hon. Gentleman was making his interesting point about the alleged rises in unit costs, my hon. and learned Friend and I were discussing exactly what the cause of these alleged increases was. Could the hon. Gentleman explain further?
§ Mr. Meacher
Residential care provision becomes more expensive at a faster rate than the increase in inflation. I recommend the hon. Gentleman to read the Loughborough paper, a major study which shows that between 1975–76 and 1980–81 there was a 2 per cent. increase in residential care places for the elderly but a 19 per cent. increase in cost in real terms. We appreciate that this is not the Government's fault, but all we ask is that they do not try to pretend that the record of the last five years is anywhere near adequate even to maintain standards, let alone improve them.
The first and crucial demand which we therefore make tonight of the Government is that if community care is not increasingly to become abandoned and if it is to mean something, they must recognise that a 2 per cent. real expenditure growth per year is wholly inadequate simply to maintain standards. If the Government will not commit themselves to a minimum annual growth target of 4 per cent. they are implicitly admitting to presiding over falling standards. That is the fact.
§ Mr. Meacher
The Minister might say that my argument is not soundly based, but I can give him abundant evidence afterwards that all of the relevant authorities such as the Association of Metropolitan Authorities and relevant organisations believe that what I have said is soundly based and that what he says is not.
490 What I have just argued, however, is not the real case against the Government. The real case against them is that such growth as there has been in the personal social services owes nothing to the Government. Indeed, growth has occurred in the teeth of the Government's most bitter resistance. Local authorities that have been determined to maintain standards, let alone improve them, have had about as much encouragement from the Government as the luckless victims of a Star Chamber inquisition. That process is now culminating in rate cutting for their pains. For the Minister to preen himself on growth in personal social services under the Tory regime when in fact they have done their utmost to prevent it by checks on local authority spending is the most nauseating of double-talk.
It is largely only those local authorities that have suffered penalties for resisting Government cuts that have saved the Government's face by introducing any real growth in personal social services. In the past five years, Islington, for example, has increased its number of home helps per thousand of population over the age of 65 from 8.8 to 11.2. That is a remarkable achievement, and I give Islington credit for it. However, Islington is now being punished by the Government and is losing one fifth of its grant through holdback. Sheffield increased the number of its home helps during the same period from 9.5 to 11.5 and is now being rewarded by having 15 per cent. of its grant held back.
It is breathtaking arrogance on the part of the Government to hammer local authorities that are committed to preserving services for overspending, to intensify the pressure on authorities by increasing holdback and then opportunistically to claim that they are protecting services for the most vulnerable. If the Minister sincerely wanted to help the most vulnerable, he would be going down on his knees to thank local authorities such as those I have mentioned, not punishing them.
§ Mr. Kenneth Clarke
As I said in my opening speech, local authorities incur penalties for the totality of their spending. Is the hon. Gentleman really suggesting that we are penalising Islington for worthwhile developments in its provision of personal social services? Has he forgotten that Islington spends money on bizarre fringe activities? I understand that it was Islington which recently hired two people to try to stop the populatiom from telling Irish jokes. That is the type of expenditure which gets Islington into penalty. It is ridiculous to assert that we are imposing penalty because it has increased the number of home helps.
§ Mr. Meacher
For the Minister to suggest that the huge cuts that have been imposed on Islington are for reasons such as that which he gave is to reduce the debate to farce. He must realise that. Penalty has absolutely nothing to do with the minuscule, trivial and tiny episode to which he referred. Besides, I have no knowledge of it. Of course it is the totality of expenditure which is being held back, but, if the Government reduce the totality, local authorities that want to maintain or improve some services will be forced to make even larger cuts in others.
It is no thanks to the Government that, fortunately, most local authorities have tried to maintain their level of personal social services. The Government are insincere. The White Paper of November 1979 reveals all too clearly that the Government intended that personal social services should be treated more harshly than any other part of the 491 public service. I am glad to see that the Under-Secretary of State is leaving the Chamber to check what I am about to say. He will be able to confirm that the White Paper envisaged a 6.7 per cent. reduction in spending on personal social services. That is what the Government intended. I believe that that is not what happened—thanks to local authorities defying the grant cutback, not to the Government's wish for an increase.
What is most worrying is that health services are rapidly deteriorating. Under the repeated hammer blows of the cuts, the number of authorities that failed to meet even the DHSS's minimal 2 per cent. real growth target is rapidly increasing. In 1979–80, a quarter of all authorities failed to meet that target, in 1980–81, nearly a half failed to do so; and in 1981–82, two thirds failed to do so. I predict that this year the figure will be 90 per cent. or more. This year it is now almost certain, in my view from looking at figures, that there will be a real overall cutback in personal social services—not just failure to meet the 2 per cent. growth target. That is a depressing prospect for many of the weakest and most vulnerable members of our society.
I urge the Government to take the one specific action that is within the parameters of their policies—I do not always agree with them — that could significantly alleviate the gathering crisis. I return, without apology, to joint finance schemes. These have been proved—we all agree — many times over as a means of sensibly transferring patients from National Health Service hospitals to local authority care. I urge the Government to reconsider the consequences of tapering arrangements for revenue expenditure as they constitute a threat to the continuation of these schemes. Several local authorities have decided not to embark upon any new, jointly financed projects, especially with rate capping imminent. They include Barnet, Knowsley, Ealing, Bexley, Newcastle, Oldham — that is my area — Sutton and Gateshead. I list them to show that not one of these authorities is one that the Minister or some of his colleagues would dare to call profligate authorities.
It is surely unfair that authorities which duly meet these commitments — which, in some cases, will increase eight-fold during the next seven years—will incur rate support grant penalties even larger than the bills.
If the Minister is serious, as I like to believe he is, in his pretensions to protect these schemes not only as a central hinge of community care provision, but as most sensible allocation of the nation's resources, I urge him strongly to reconsider what he said and to consult again with his colleagues—because this is not just a matter for him— in the Department of the Environment and the Treasury with a view to ensuring that this expenditure is disregarded in calculating, if not targets, liability for grant holdback.
A devastating crisis is building up in community care. It is fuelled by inadeqate expenditure outlays, and now annual cuts; by grant penalties, and now rate-capping; by rapidly growing demand; by rising unit costs of residential care provision, and by a dogmatic Government attitude towards joint finance schemes which, sadly, will deny thousands of elderly, disabled and chronically ill people the community care that they desperately need. If their voice is not heard, because they are not organised, do not have the capacity to demonstrate or the power to withdraw their labour, that is not a reason why the House should ignore their plea.
492 Nor do cutbacks make even economic sense. Some of those in the community who could have coped with support will deteriorate more swiftly and make demands on expensive health services. The knock-on effect of reduced support services and the subsequent increased demand and other inroads made by patients into the patient health care system, will achieve the opposite of what the Government intend. The effects will be long term. In community care, today's cuts are tomorrow's crisis. That is why the Opposition are opposing the application of damaging and short-sighted cutbacks to the weakest and most vulnerable members of our society.
§ 9.5 pm
§ Mrs. Anna McCurley (Renfrew, West and Inverclyde)
As the time available is short, I shall endeavour to be brief. Following the Minister's excellent exposition of the Government's case in maintaining support for the funding of community services, the Opposition response clearly showed that they do not understand either the financing or the will of the Government. There is no doubt about the Government's commitment to the funding of community services and, indeed, all social services.
When in opposition, Conservative Members were faced with a Labour Government who were adding to massive inflation. We looked for an alternative source of funding care in the community. We were concerned about the people mentioned in the motion. We looked to the voluntary services, and since then we have been consistent in our support for them. In 1980 a Conservative Chancellor of the Exchequer released £300 million into the voluntary sector, through tax concessions on gifts and bequests and employment costs.
It is not the Government's will for funding that is wrong, but the attitude of Socialist-controlled local authorities. I have experience of local authorities, and know that they have an intense dislike of the voluntary sector, because they are concerned to maintain centralised control over their expenditure. I see that happening in my authority in the share-out of finances for child care and the squeezing out of the voluntary sector.
Local authorities, despite the restraints on them, are still empire building. They built empires to such an extent that they increased their staff levels to a ridiculous point. During a recent discussion with the hon. Member for Clackmannan (Mr. O'Neill), he described the local authority system as a form of Stalinism. Those were his words, not mine, but I am forced to agree with him. The attitude of local authorities has contributed greatly to a consistent budgetary overspend. Local authorities, especially Socialist local authorities, are failing to establish priorities.
My local authority of Strathclyde has been innovative and courageous in many respects. It can cope with its statutory obligations within its budget. It has a strong child-oriented policy, which stems from a document called "Born to Fail", which told of the multiple deprivation suffered by many children in the Strathclyde region. At the same time, the Government are injecting into that authority massive sums of urban aid which go to assist those children.
There is a declining population of children. It is high time that we looked at the balance of the budget. As we have heard many times tonight, the elderly population is increasing. I appreciate, as we all do, the problems of the 493 elderly. Despite the fact that we know that the problem is growing in intensity, little has been done by local authorities to care for the elderly. There is a great deal of cant at local authority level when talking about the elderly. Local authorities have it in their power to make policy decisions to help the old. My authority attacked one of the most vital services upon which the elderly depend—the home help service. In other words, it was playing a cynical game with the Government at the expense of these elderly people.
Let me revert to the record of care of voluntary bodies which, in association with local authorities, help our elderly people. We can see from the statistics how the voluntary services benefit our elderly people. However, the way in which they operate casts severe doubts on the operation and the budgeting of local authorities. I can quote from the Scottish abstract of statistics. In March 1979 there were 39 local authority day centres in Scotland, with 1,355 places. In March 1982 there were 64 day centres, with 2,212 places. The voluntary register of day centres shows that in March 1979 there were 10 day centres, with 2,168 places, and in March 1982 there were 11 day centres with 2,740 places. Those figures show that the 11 voluntary day centres serve more people than 64 local authority day centres. This, above all, shows clearly the benefit which the voluntary sector gives us.
It has been said tonight that joint financing with health authorities is an excellent arrangement. In theory it is in some districts, and is working extremely well, but in my region it is working extremely badly. Despite the heavy increase in Government commitments to joint financing, there appears to be, at local level, a failure to understand the needs of the elderly. Local authorities talk in grandiose terms about geriatric hospitals and the need for geriatric provision. However, geriatric provision is only a small portion of the needs of older people. Most people over the age of 70 are not geriatric in the medical sense—they are just getting old. The problem is the failure of the liaison committees to differentiate between elderly, confused, frail people who can be coped with in the community and low-key nursing day centres, and those who need geriatric services. It is this squabbling and the failure to establish definitions that have inhibited progress in getting not only the assessment but the financing right, and getting on with the job of making the provisions right.
We have only one problem in our part of the world. Much of that problem can be laid fairly and squarely at the door of Socialism. There is a failure on the part of many people to be personally responsible for their elderly people. Governments can reflect the compassion of a society, but it is difficult for Governments to try to teach people compassion. One of the dreadful problems that we face is that elderly relatives who have been transferred from their homes or those of their relatives into hospital find that when they are out of what might be called the geriatric term, have been rehabilitated back into the community and are sent back home, they are rejected by their families.
Part of the burden on the social services arises from the failure of people to take responsibility for their elderly relatives. I urge the joint liaison committees to look more closely into the counselling of relatives. There is an urgent necessity to fund this movement. The movers of the motion did not talk about personal responsibility. One of 494 the Government's policies in every subject has been to make people aware of that and to move us back towards it. In supporting the Government we shall be well on the way to doing that.
§ Mr. David Alton (Liverpool, Mossley Hill)
The last time that I heard the Minister for Health speak was three weeks ago in the Cambridge Union, when we were opposing each other in a debate on whether the proliferation of parties in British politics was a good or a bad thing. I was arguing that it would be a good thing and on that occasion I am glad to say that we won the debate. I expect that tonight the vote may go differently.
§ Mr. Alton
The Under-Secretary took part in the Adjournment debate last night at which I was present. He will know that that is regularly the case, unfortunately, in the House.
The debate has been a good example of two parties such as the Social Democratic and Liberal parties airing an issue that might not otherwise be debated during the mainstream time of Parliament. The contributions this evening from the hon. Member for Oldham, West (Mr. Meacher) and from Conservative Members demonstrate that this is an issue upon which people feel strongly, across the Chamber, and have important contributions to make.
Many of us come from what might be called the cod liver oil and orange juice generation, and we have watched with a great deal of worry as we have seen the frontiers of the welfare state being rolled back. In particular, it has become a great crusade to talk in terms similar to those in which the hon. Member for Renfrew, West and Inverclyde (Mrs. McCurley) spoke, when she talked about the need for the individual to assert himself and take responsibility. No alliance Member would disagree with that argument, but we also believe that a safety net should be provided. The hon. Lady will not be surprised, as other hon. Members will not be, at heirs of a legacy that goes back to David Lloyd George, William Beveridge and Keynes offering a motion such as this.
We offer this motion in a constructive way. Much of the rhetoric has come from the Government — not necessarily from the Minister, but from many of his colleagues—is not a rhetoric that does any good to the social services, the Health Service or the welfare state. We believe that it stems from a basic philosophy which expects the individual to survive where might and greed are important and where vulnerability is not believed to be at all important.
It is worth looking at the writings of that great Tory party guru, Milton Friedman, to see where the party gets much of its thinking. He said:Indigence was simply the punishment meted out to the improvident by their own lack of industry and efficiency. Far from being a blessed state, poverty was the obvious consequence of sloth and sinfulness".The concept that sloth and sinfulness should be the reason why people are poor or vulnerable defeats me. It is based on the argument that one must blame the victim, and that the victim is responsible for the circumstances in which he lives.
I referred a moment ago to Sir William Beveridge. In his maiden speech in the House in 1944, he said:I suggest that our aim should be that every British citizen, who works while he can and contributes while he is working and 495 earning, should be assured of an old age without want, without dependence on the young, and without the need for charity or assistance".—[Official Report, 3 November 1944; Vol. 404, c. 1127.]That is something for which Liberals will go on arguing in this Chamber all these years later.
One can go back even further than that, to the time of David Lloyd George who, in 1909, said:I cannot help hoping and believing that before this generation has passed away we shall have advanced a great step towards that good time when poverty and wretchedness and human degradation which always follow in its camp will be as remote to the people of this country as the wolves which once infested its forests".For Liberals, 70 years later, it is profoundly disturbing that the rhetoric of Thatcherism has all but become the orthodoxy of political language. Butskellite corporatism has been replaced by a meaner and more selfish approach which all too readily blames the victim. That approach is again exemplified by Friedman, who warned that the major evil is theeffect [of welfare programmes] on the fabric of our society. They weaken the family, reduce the incentive to work, save and innovate; reduce the accumulation of capital and limit our freedom.Life may look like that from the Downing street bunker, but for those of us who are outside it, that theory appears to be devoid of humanity and sanity. Exhortations to privatise, to self-help, for family life, for the return of women to their homes, for Victorian virtue, for saving, for rationalisation and for efficiency, are all important, but they are no substitute for the care that the vulnerable in our community have a right to expect.
§ Mr. Alton
I shall give way in a moment.
Malcolm Dean, writing in The Guardian, put it well when he described this Administration asa Government which does not feel guilty about the poor.David Donnison, as chairman of the Supplementary Benefits Commission, concluded thatThe new team has shed the burden of social conscience.
§ Mr. Parry
Is not the hon. Gentleman adopting the usual Liberal attitude of playing both sides against the middle? He referred to David Lloyd George, but he would be more up to date if he referred to Sir Trevor Jones, who was leader of the Liberal party in Liverpool for many years. Under Liberal leadership, social services, the sick, the disabled and home helps in Liverpool were attacked. Now that a Labour-controlled council is in power the Liberals are playing the same game by attacking the Labour party for trying to put right the mess in which the Liberals and Tories left us.
§ Mr. Alton
I shall refer to home helps later. The hon. Member for Liverpool, Riverside (Mr. Parry) is wrong when he suggests that the Liverpool city council is acting differently from any other council in the country. The hon. Member for Oldham, West (Mr. Meacher) made the point earlier—I use this point to refute what the hon. Member for Riverside has just said—that every single council in the country has had its funding reduced. One cannot make a silk purse out of a sow's ear. No Liberal would blame the present Government or any other Government for Britain's economic malaise, but we believe that the Government stand condemned for their failure to stand up for those most in need and for their stigmatisation of dependency. The Government boasted earlier that 496 personal social services had not been cut, but, as I argued yesterday and have argued before, demographic changes mean that there are new challenges and that resources must increase and not just stand still. Many local authority cuts are rational decisions, given the reduced expenditure available to them. Boarding out for children and day care services for the mentally ill have been improved. There have been improved services, but that is because those were sensible economic and, some would argue, socially sensible decisions to take. That does not make them bad, but at the same time they are determined by the financial restraints placed on local authorities. It is easy to dispose of home care helps, because often those people are employed for short periods. Many local authorities have made massive reductions in home care helps.
The situation in the city of Liverpool is highly unsatisfactory. Last year Liverpool had 1,900 clients and only 144 home helps to meet that need. The DHSS guidelines say that it should have 967 home helps. I have argued in the past that it is madness to have more than 67,000 people there being paid over £5,500 a year to stay in the dole queue when work remains to be done. In other words, that relates a need in the community to people available to do it. We should be improving our home help service, taking demographic changes into account and ensuring that meals on wheels and other important facilities for the elderly are provided.
§ Mrs. Edwina Currie (Derbyshire, South)
Does the hon. Gentleman agree that it is an absolute disgrace for a city the size of Liverpool, with about 400,000 people, to have only 144 home helps? Will he further agree that that has been due to the policy of the local authority? Birmingham, only twice the size, has about 2,000 home helps.
§ Mr. Alton
A city which has lost over £100 million in rate support grant as the result of Government cuts in the last four years must make savings and cannot meet all its needs. We are speaking of a city which has one in four of its population over the retirement age, with the fastest growing group the over-80s. That is clearly an argument for increased provision, but local authorities cannot make a silk purse out of a sow's ear.
It is a problem facing not only the city of Liverpool. The hon. Member for Oldham, West referred to the Association of Metropolitan Authorities. That organisation estimates that as a result of cuts in expenditure, 7,000 places will be lost in old people's homes, 40,000 fewer people will have home help visits, 50,000 fewer meals will be delivered and 60,000 teaching jobs, and a further 40,000 non-teaching jobs will be slashed.
Those figures come not just from think tank reports or reports leaked to The Guardian. We have seen the reality of Conservative policies in the last four years. The unified housing benefit resulted in 2 million vulnerable people being made an average of 75p a week worse off, and 200,000 other people, according to SHAC, are not claiming benefits to which they are entitled. That is a direct result of Government policies.
The challenge is enormous. It is estimated that there are today 7 million people dependent on supplementary benefit; that for every 100 people on the poverty line in 1979 there are now 160; that the number of claimants of working age on supplementary benefit has doubled; and that by 1984 there will be almost 2 million children on 497 benefit. The same is true of the elderly. It is estimated that by the year 2001 the number of people aged over 75 will have risen by about 493,000 and that the number aged over 85 will have increased by about 288,000. That means a greater need for more sheltered accommodation, more bungalows for the elderly and greater protection for the elderly.
I urge the Government to consider implementing the terms of the Victims of Violent Crimes Bill that I introduced two years ago. That would ensure that elderly people were provided with alarms, telephones and porterage systems and that more assistance was given to the establishment in the community of victim support schemes. It cannot be right that there should be only 150 voluntary victim support schemes throughout the country. There should be many more. At present they are receiving the pittance of £50,000 a year from the Government. When elderly people become the victims of violent crime, the DHSS gives them only £2 a day on which to live, yet many of them have lost the electricity and gas money and even money for food. That is a practical way in which the community, and especially the Government, can respond.
In his opening remarks the Minister made an important statement about child care. I welcome that statement, which corresponded closely to a child care measure which I introduced 18 months ago. Many of the announcements that he made tonight are much needed because of the Kafkaesque cycle where social workers have sat as judge and jury, defence and prosecution when dealing with their clients. I welcome what the Minister said tonight but, as he accepted, it does not go all the way. There is still scope for the introduction of measures such as family courts and I hope that in the longer term the rights of the individual child will matter just as much as those of the parent. It is about time that the balance between the power of the social worker and the individual was redressed.
To Liberals, the community and its needs are a starting point. We see its demands as a stimulating challenge. That is why we and our hon. Friends in the Social Democratic party who have tabled the motion tonight commend it to the House.
§ Mr. Michael Meadowcroft (Leeds, West)
I hope that hon. Members will understand if I do not pick up every point that has been made in the debate. The Minister began by making great play of the money that has been spent by local authorities in the past five years. He talked about a growth of 12.7 per cent. In fact, the money that has been put into social services is not a Government but a local government miracle. Despite Government efforts to cut back on expenditure, local authorities have managed to keep pace with needs, and that is what is amazing. Despite the ravages imposed by the Government, many local authorities have developed social services in the ways in which I and my hon. Friends would wish.
It is not only demographic matters which require the money spent on social services to be increased; it is also such things as the demands of new legislation, and that has not been mentioned tonight. That inevitably puts new demands on local authorities which the Government never seem to recognise by making resources available to them. Above all, unemployment is the engine which increases the need for expenditure on social services. The 498 correlation between the needs of the social services and unemployment has been demonstrated time and again. I hope that Conservative Members appreciate that while they have policies which increase unemployment to such an amazingly high level, the needs of the social services will inevitably increase.
It is easy to talk about the global figures and say that in so many million pounds there must be waste to cut out. Everybody appreciates that it is easy to say that and perhaps, here and there, there is. However, one can only do so for so long. There is bound to be a point at which it cannot be done. To say that there are administrative savings to be made is to do a great disservice to the many people who are underpinning the social workers—the case workers and those who go out into the streets. They are doing a great deal of financial and administrative work in the local authorities. It is a juggling of resources that can only go on for so long.
It is interesting to quote the Select Committee on Social Services which reported in July 1982. Despite what the Minister said, the Committee found:Day care places have fallen in proportion to the population over 75 since 1979–80, as have the number of hours of home help contact for that population. Between 1975–76 and 1980–81, home help hours of service to those over 75 failed by 8 per cent. to keep pace with the growing numbers of elderly, and meals served to those over 75 failed by 11.6 per cent.Those figures were not produced by some local authority or its association which Conservative Members disparage but by a House of Commons Select Committee.
The Minister talked about pump priming and the new money being produced. It is fine to develop pump priming but often in doing so there is insufficient time to see where the money will come from to sustain it. Voluntary bodies have been put under immense pressure by being given finance only from year to year. Many people will not come into pump priming exercises and experimental schemes when there is no prospect of employemt for longer than one year. That applies, for example, to Opportunities for Vounteering — a splendid scheme but, unfortunately, employment is guaranteed for only 12 months at a time. When I was working in the voluntary sector I found it difficult to expect people to enter employment when there is no greater guarantee.
The Minister talked about the Government's new ideas and new money. Looking at the global figures for local government it seems that much more has been taken away. However, there is another problem that the Minister must face; that is that, in many experiments—many of the good schemes that the voluntary sector has taken on—there is a great bulge of time expiry. Unless the Government pick up the point that many schemes will now fail if they do not provide more resources for them, many good schemes will fail to continue. The great majority of the schemes are not being evaluated and there is no suggestion of any possibility of continuing schemes that have proved to be successful. The Government's figures are therefore not always what they seem, because many schemes will fail and disappear in the very near future.
The Government have put great pressure on the local authorities and the voluntary bodies to embark on more capital projects, without recognising that there are revenue implications in every case. Great problems will face a voluntary body that takes on a capital scheme of any kind without the provision of revenue expenditure to underpin it. I could give a number of examples, taken from around the country, of cases in which a voluntary body has taken 499 on a scheme under the encouragement of the Government but because of such under-funding, is having great difficulty in continuing it.
I am sorry that the hon. Member for Suffolk, South (Mr. Yeo) is not in his place. His views today were much more muted than they were on the last occasion I heard him speak, when we shared a platform before the election. The hon. Gentleman then made most trenchant criticisms of the Government. It is astonishing now to realise what changes were wrought by 9 June, and to hear the hon. Member giving the Government so much support. I remember that the hon. Gentleman made tremendous criticisms of the imposition of VAT on voluntary bodies. I would have expected him to make that point today.
I welcomed and appreciated the comments of the hon. Member for Oldham, West (Mr. Meacher), particularly his comments on the choice of subject. In view of those comments, it may be churlish to criticise the hon. Gentleman. However, some of his colleagues, particularly in the local authorities, do not seem to believe as strongly as he does in community care. Many people in the voluntary bodies believe that many Labour-controlled local authorities prefer to believe that if something is worth doing, the state must do it. One cannot have it both ways. If they believe in community care—if they believe in the place of the voluntary sector in society—those local authorities must encourage the voluntary bodies to pick up some of the schemes that are most appropriate to them.
One phrase used by the hon. Member for Renfrew, West and Inverclyde (Mrs. McCurley) gave away much of her case. She said that when local government is under pressure, we look to the voluntary bodies. That is not the spirit in which we should encourage the partnership between the statutory and the voluntary sectors. One should not turn to the voluntary sector in an escapist fashion when there are financial pressures. It was unfair of the hon. Lady to compare the services provided by the voluntary sector with apparently comparable services in the statutory sector. Very often, and for very good reasons, the voluntary sector is not coping with those in the greatest need in any one category. For example. a considerable amount of good work in sheltered housing is done by the voluntary bodies. However, I know from my own experience in Leeds that, by and large, they do not take in people in the same depths of need as do the statutory services. Inevitably, therefore, the statutory services in that sector will have greater costs to meet.
The hon. Lady then mentioned personal responsibility. No one would doubt that personal responsibility is crucial, but many people are taking on burdens of responsibility that they cannot possibly cope with. At a conference, I heard a speaker from the Association of Carers, which is trying to find ways of giving people respite care —giving them some time off from caring. She told us of someone who was caring for a very elderly parent, who said that she was frightened of respite care. She was terrified of having her door opened to the world, and of not wanting to go back in after a period of respite care. It is a question of enabling people to carry on with day-to-day caring. We should not just tell them that it is their personal responsibility. There are costs involved in that, which local authorities and the Government must take on.
No one would dispute that joint financing is important. The increased flexibility that the Government have provided is most valuable and is to be welcomed. However, the Government must accept that local 500 authorities will not want to avail themselves of such flexibility if their general expenditure is to be attacked through rate penalties. The authority will not be able to cope without making cuts elsewhere. It is ridiculous that a local authority social services department should have to decide, for example, between not taking up more home help places and continuing previous jointly financed projects.
I hope that the debate has highlighted the importance of linkages. There are linkages between social security provision and the NHS, and between the social services and the NHS. Unless the debate concentrates on those areas, they will be hidden behind the smokescreen of the total cuts imposed. For example, the hon. Member for Bradford, West (Mr. Madden) has Thornton View hospital in his constituency. Indeed, it was mentioned the other day in the debate on the NHS cuts. An interesting fact about that hospital is that Bradford social services department is on the same site. Some years ago Bradford social services department asked about the future of that hospital, and were told that it was assured. Consequently, the local authority invested considerable funds. However, having expended considerable resources, the authority is now faced with a threat to the hospital. The linkage between the NHS and the social services has not been maintained and as a result all three political leaders on the local authority have written to the Minister saying that they want Thornton View to remain open and quoting their input into that scheme.
The Government do not seem to understand what it means to draw together the different forces within the community. There are tremendous strengths in the community and there is tremendous power at a neighbourhood level. Unfortunately, the Government's divisive policy in so many different spheres undermines that strength and prevents it from being liberated. For example, the stigma attached to those on unemployment benefit means that they feel unable to claim the sums due to them, because they are made to feel that they are scroungers. After all, attitudes are just as important as reality.
I was struck by an article that appeared in today's edition of The Times and which was written by Sir William Rees-Mogg. — [Interruption.] I would not have thought that he was a hostile witness. He said:All wisdom about human affairs depends on humility, sympathy, and the search for general rules.There is very little humility or sympathy on the Government's side. The search for general rules has become a desire to dominate from the centre. Time and again the Government hide behind global figures. They give us all the global figures, but they will not respond—as my hon. Friend the Member for Isle of Wight (Mr. Ross) said—to the point that what is happening at the grass roots level bears no relation at all to those figures. If there is so much money available and so much growth, why do local authorities have to agonise about whether to close wards or cut the numbers of home helps? It just does not add up. I hope that the House will reject the amendment and support the motion.
§ The Under-Secretary of State for Health and Social Security (Mr. John Patten)
I have only 16 minutes in which to attempt to reply to the debate. That is rather different from the situation in which I found myself last 501 night following the debate on health care in the Liverpool region. I then had two and three quarter hours in which to conclude the Adjournment debate. I thought for one ghastly moment, when warfare was breaking out between the hon. Member for Liverpool, Riverside (Mr. Parry) and the hon. Member for Liverpool, Mossley Hill (Mr. Alton), that I was back in the middle of the nightmarish two and a half hours which I faced last night.
The debate has been most interesting and the Government are grateful to the Social Democratic party and the Liberal party for tabling the motion, but I am less grateful and very surprised at the terms in which it is expressed. The motion, is not redolent of the reasonable and reasoned public face which the alliance likes to put before the electorate. Instead, it is redolent with words of condemnation of what the Government are doing. The motion might well have been written by that late lamented-figure the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), who was until recently the Front Bench spokesman for the Opposition. It is within the lingua franca— [HON. MEMBERS: "Bring her back!"] I agree. We should bring her back.
There was a weak display of statistical expertise by the hon. Member for Oldham, West (Mr. Meacher). Following the fashion set by the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), he wandered out of the Chamber but has now just returned to hear my strictures. We used to have a noisy debate when the hon. Lady for Crewe and Nantwich was present. We miss her very much. We are obviously going to have a statistical time in future.
I suggest that the hon. Member for Oldham, West considers the implications of the statistics that he uses. The hon. Gentleman suggested that one of the reasons why expenditure on the personal social services had increased was that unit costs were rising. After my intervention—to which he gave way, but I do not intend to allow him to interrupt me because I do not have sufficient time—the hon. Gentleman said that that was because of a 19 per cent. increase in the cost of residential homes, as though an immutable Meacherite law decreed that unit costs rise exponentially.
§ Mr. Deputy Speaker (Mr. Harold Walker)
I am sorry to interrupt the Minister when he is in mid-flow, but I would be helped, as would the House and the Official Report, if he would try to avoid turning his back on the chair.
§ Mr. Patten
I am extremely sorry, Mr. Deputy Speaker. I apologise for turning my back on you. I meant no personal disrespect at all. I thought that I was about to be ticked off for using the word "Meacherite". I am relieved that I am not to be pulled up by yourself, Mr. Deputy Speaker, for using that word.
The hon. Member for Oldham, West when referring to the 19 per cent. increase, suggested that that proved that we needed more expenditure in the personal social services but he did not stop to think for one moment whether the increase in public expenditure was necessary or whether good management might improve the position.
The terms of blanket condemnation in which the motion has been written are disappointing and uncharacteristic of the alliance generally and of its public face.
502 I was equally disappointed, I am afraid, in what was otherwise an excellent and fluent speech by the hon. Member for Ross, Cromarty and Skye, in the way in which he condemned almost everything that the Government had done. The one exception was a brief and halting sentence about the increased expenditure on voluntary sector funding in this country. Tomorrow's Official Report will show that what I have said is correct. That, too, is most disappointing. I hope that the hon. Gentleman will not regard it as impertinent if I commend to him the quaint old-fashioned habit of staying in the Chamber to hear the rest of the debate after making one's own speech. I was sorry that he saw fit to leave so soon after the end of his contribution, not returning until 9.25 pm. Apart from anything else, he missed a number of charming compliments on the excellence of his speech. It would certainly have been agreeable if he had listened to the rest of the debate.
In many ways, the most constructive speech today was that of the hon. Member for Swansea, East (Mr. Anderson). Unfortunately, he is not in his place to hear my compliments. Although he strongly criticised a number of aspects of Government social policy he made a thoughtful and balanced contribution with some particularly interesting suggestions as to ways in which we might improve neighbourhood care in this country.
A similarly constructive approach characterised the interesting but brief speech of the hon. Member for Leeds, West (Mr. Meadowcroft), who wound up the debate for the alliance. Leeds must be an interesting place to live in, with Balliol and bar-room brawling in Leeds, East and J. B. Priestley pragmatism in Leeds, West—a rather undistinguished sting in the tail that the hon. Gentleman will regret having read on to the record.
Extremely constructive also was—[HON. MEMBERS: "Come on—you have only 10 minutes."] I know that the Opposition are enjoying my speech and would like me to go on for longer. In the time remaining I intend to deal with a number of aspects entirely untouched by the alliance speeches — with the exception, again, of the hon. Member for Leeds, West, who at least mentioned the carers. It is unfortunate that the Opposition have shown no care for the carers who give so much help to society. That is in contrast with the speech of my hon. Friend the Member for Suffolk, South (Mr. Yeo), who picked out this important area for attention. Far from deserving the blanket condemnation that we have received from the Opposition, the Government have done a great deal in this area. The support needed for carers varies widely. The Department's social work service has undertaken an important and widely praised development work project to give extra help to the carers who do so much to help the social services. That is a most important aspect.
I draw the attention of alliance Members to some of the positive and entirely innovatory achievements that the Government have managed in the past two or three years. The number of innovations in relation not just to carers but across the board that have been announced by my right hon. Friend the Secretary of State is considerable. Behind many of those innovations has been the fertile brain and political imagination of the Under-Secretary of State, my hon. Friend the Member for Braintree (Mr. Newton), who is responsible for the disabled and has contributed a great deal to the development of the social services in this country in recent years.
503 I cite just one example of the advances that have been made. The Department has been giving support to the central costs of the national Council for Carers of Elderly Dependants. It has been giving financial aid to the Association of Carers specifically to give help in this area. We have recently added to the list of organisations. It is important to go into detail here, as the hon. Member for Leeds, West has claimed that we are fond of talking in global figures but do not know what it is like at the grass roots. We have recently given a grant of £50,000 spread over two years to support a brand new grassroots organisation concerned with helping the carers to whom my hon. Friend the Member for Suffolk, South referred in his admirable speech—an organisation called Contact-a-Family. We also support organisations such as MENCAP and the National Schizophrenia Fellowship which undertake detailed grassroots work in important areas.
In view of the contribution made by the Government to the voluntary sector and to alternative ways of coping with need, I thought it a bit much that the alliance's somewhat overdramatically written motion did not recognise any of the great developments that the Government have achieved. A number of areas of co-operation underlie our ever-deepening relationship with the voluntary sector. It is a great shame that the alliance, which sets such store on being fair and even-handed, chose not to recognise those facts today. Do alliance Members decry the fact that the volume of resources given to voluntary organisations has increased by 11 per cent. since last year? Is that a good thing or a bad thing? Do they decry the fact that the overall financial support to the voluntary sector, excluding that from local authorities, has increased to £25 million this year from £15 million last year?
I was pleased to hear the hon. Member for Leeds, West, in the thoughtful part of his speech, and before the unfortunate sting in the tail—the sting that turned round and stung him—commend the scheme for opportunities for volunteering. That has been a great success, particularly in the local framework at the. grassroots. My hon. and learned Friend the Minister for Health talked about our global achievements because we are proud of them. Everything at national level is mirrored locally at the grassroots, where much social care is carried out by voluntary organisations, statutory organisations and our excellent social workers.
It is unfortunate that sometimes the tabloid newspapers gratuitously attack the social work profession, which does so much good. Are alliance Members not content, for example, with the way in which the Government have ensured better communications with the voluntary sector by giving them places on the joint consultative committees, which plan the funding made available through the joint funding process? It strikes me as unreasonable and irrational of the alliance to ignore the fact that during the Government's years of office real resources, taking account of the rise in prices, devoted to joint finance have increased by 50 per cent. That is one of the Government's major achievements in social services and one of which the Minister for Health is rightly proud.
The Government have introduced special detailed initiatives in intermediate treatment, and in day care for the under-fives. They have made more advances than any Government since the second world war. Pilot projects for psychogeriatrics are springing up all over the country, which are at the feet of the Government to put into action. The Government have changed the law relating to 504 voluntary and private homes to integrate them more into the social provision framework. We owe much to voluntary homes. It is important to get mentally handicapped children out of hospital. All those introductions, both in terms of money and the detailed grassroots provision, are part and parcel of the Government's aim to support dependent people and children in the community. I hope that alliance Members will support that, rather than decry it in the overall blanket condemnation in their motion on the Order Paper.
The Conservative party and the Conservative Government have taken the concept of care in the community, provided resources for it and made it a living phenomenon and not merely the dream of social workers and social theorists. That is one of the Government's great achievements since 1979. For that reason, I invite my right hon. and hon. Friends to reject this absurd, irrelevant and most un-alliance-like motion.
§ Question put, That the original words stand part of the Question:-
§ The House divided: Ayes 46, Noes 164.505
|Division No. 65]||[10.00 pm|
|Alton, David||Meacher, Michael|
|Ashdown, Paddy||Meadowcroft, Michael|
|Bermingham, Gerald||Nellist, David|
|Bruce, Malcolm||Owen, Rt Hon Dr David|
|Carlile, Alexander (Montg'y)||Parry, Robert|
|Cocks, Rt Hon M. (Bristol S.)||Pavitt, Laurie|
|Davis, Terry (B'ham, H'ge H'l)||Penhaligon, David|
|Fields, T. (L'pool Broad Gn)||Pike, Peter|
|Fisher, Mark||Prescott, John|
|Freud, Clement||Robertson, George|
|Golding, John||Rogers, Allan|
|Haynes, Frank||Ross, Stephen (Isle of Wight)|
|Howells, Geraint||Sheerman, Barry|
|Hoyle, Douglas||Skinner, Dennis|
|Hughes, Simon (Southwark)||Steel, Rt Hon David|
|Jenkins, Rt Hon Roy (Hillh'd)||Stott, Roger|
|Johnston, Russell||Wainwright, R.|
|Kennedy, Charles||Wallace, James|
|Kirkwood, Archibald||Warden, Gareth (Gower)|
|Loyden, Edward||Wareing, Robert|
|McKay, Allen (Penistone)||Wrigglesworth, Ian|
|McWilliam, John||Tellers for the Ayes:|
|Madden, Max||Mr. A. J. Beith and Mr. John Cartwright.|
|Marek, Dr John|
|Adley, Robert||Coombs, Simon|
|Amess, David||Cope, John|
|Ashby, David||Couchman, James|
|Atkins, Rt Hon Sir H.||Currie, Mrs Edwina|
|Baker, Kenneth (Mole Valley)||Dicks, T.|
|Baker, Nicholas (N Dorset)||Dorrell, Stephen|
|Baldry, Anthony||Dover, Denshore|
|Batiste, Spencer||Dunn, Robert|
|Bellingham, Henry||Eggar, Tim|
|Biggs-Davison, Sir John||Evennett, David|
|Boscawen, Hon Robert||Eyre, Reginald|
|Bottomley, Peter||Fallon, Michael|
|Bowden, Gerald (Dulwich)||Finsberg, Geoffrey|
|Bright, Graham||Fookes, Miss Janet|
|Brinton, Tim||Forth, Eric|
|Brown, M. (Brigg & Cl'thpes)||Fowler, Rt Hon Norman|
|Bruinvels, Peter||Fox, Marcus|
|Buck, Sir Antony||Franks, Cecil|
|Bulmer, Esmond||Garel-Jones, Tristan|
|Butcher, John||Goodlad, Alastair|
|Butterfill, John||Griffiths, Peter (Portsm'th N)|
|Chope, Christopher||Grylls, Michael|
|Clark, Dr Michael (Rochford)||Hampson, Dr Keith|
|Clarke Kenneth (Rushcliffe)||Harris, David|
|Hawkins, C. (High Peak)||Proctor, K. Harvey|
|Hayward, Robert||Raffan, Keith|
|Heddle, John||Rathbone, Tim|
|Hirst, Michael||Rhodes James, Robert|
|Hogg, Hon Douglas (Gr'th'm)||Robinson, Mark (N'port W)|
|Howard, Michael||Roe, Mrs Marion|
|Howarth, Alan (Stratf'd-on-A)||Rowe, Andrew|
|Hunt, David (Wirral)||Ryder, Richard|
|Hunt, John (Ravensbourne)||Sackville, Hon Thomas|
|Hurd, Rt Hon Douglas||Sainsbury, Hon Timothy|
|Jackson, Robert||St. John-Stevas, Rt Hon N.|
|Jones, Robert (W Herts)||Sayeed, Jonathan|
|Key, Robert||Shaw, Sir Michael (Scarb')|
|Leigh, Edward (Gainsbor'gh)||Shelton, William (Streatham)|
|Lewis, Sir Kenneth (Stamf'd)||Shepherd, Colin (Hereford)|
|Lilley, Peter||Smith, Sir Dudley (Warwick)|
|Lord, Michael||Smith, Tim (Beaconsfield)|
|Luce, Richard||Soames, Hon Nicholas|
|Lyell, Nicholas||Speed, Keith|
|McCrindle, Robert||Speller, Tony|
|McCurley, Mrs Anna||Spencer, D.|
|Macfarlane, Neil||Spicer, Michael (S Worcs)|
|MacGregor, John||Stanbrook, Ivor|
|MacKay, John (Argyll & Bute)||Stern, Michael|
|Maclean, David John.||Stevens, Lewis (Nuneaton)|
|McNair-Wilson, M. (N'bury)||Stevens, Martin (Fulham)|
|Major, John||Stewart, Andrew (Sherwood)|
|Malins, Humfrey||Stradling Thomas, J.|
|Malone, Gerald||Thomas, Rt Hon Peter|
|Maples, John||Thompson, Patrick (N'ich N)|
|Marlow, Antony||Thome, Neil (Ilford S)|
|Mather, Carol||Thurnham, Peter|
|Maude, Francis||Townsend, Cyril D. (B'heath)|
|Maxwell-Hyslop, Robin||Tracey, Richard|
|Mayhew, Sir Patrick||Twinn, Dr Ian|
|Mellor, David||van Straubenzee, Sir W.|
|Merchant, Piers||Vaughan, Dr Gerard|
|Miller, Hal (B'grove)||Viggers, Peter|
|Mills, lain (Meriden)||Waddington, David|
|Mills, Sir Peter (West Devon)||Wakeham, Rt Hon John|
|Moate, Roger||Walden, George|
|Moore, John||Waller, Gary|
|Morris, M. (N'hampton, S)||Wardle, C. (Bexhill)|
|Morrison, Hon C. (Devizes)||Warren, Kenneth|
|Morrison, Hon P. (Chester)||Watson, John|
|Murphy, Christopher||Watts, John|
|Neale, Gerrard||Wells, Bowen (Hertford)|
|Newton, Tony||Wheeler, John|
|Nicholls, Patrick||Wiggin, Jerry|
|Normanton, Tom||Winterton, Nicholas|
|Norris, Steven||Wolfson, Mark|
|Onslow, Cranley||Wood, Timothy|
|Oppenheim, Philip||Woodcock, Michael|
|Ottaway, Richard||Yeo, Tim|
|Page, John (Harrow W)||Young, Sir George (Acton)|
|Page, Richard (Herts SW)|
|Patten, John (Oxford)||Tellers for the Noes:|
|Powell, William (Corby)||Mr. Donald Thompson and Mr. Michael Neubert.|
|Prentice, Rt Hon Reg|
§ Question accordingly negatived.
§ Question, That the proposed be there added, put forthwith pursuant to Standing order No. 33 (Questions on amendments):—
§ The House divided: Ayes 161, Noes 40.507
|Division No. 66]||[10.10 pm|
|Adley, Robert||Biggs-Davison, Sir John|
|Amess, David||Boscawen, Hon Robert|
|Ashby, David||Bottomley, Peter|
|Atkins, Rt Hon Sir H.||Bowden, Gerald (Dulwich)|
|Baker, Kenneth (Mole Valley)||Bright, Graham|
|Baker, Nicholas (N Dorset)||Brinton, Tim|
|Baldry, Anthony||Brown, M. (Brigg & Cl'thpes)|
|Batiste, Spencer||Bruinvels, Peter|
|Bellingham, Henry||Buck, Sir Antony|
|Bulmer, Esmond||Murphy, Christopher|
|Butcher, John||Neale, Gerrard|
|Butterfill, John||Newton, Tony|
|Chope, Christopher||Nicholls, Patrick|
|Clark, Dr Michael (Rochford)||Normanton, Tom|
|Clarke Kenneth (Rushcliffe)||Norris, Steven|
|Coombs, Simon||Onslow, Cranley|
|Cope, John||Oppenheim, Philip|
|Couchman, James||Ottaway, Richard|
|Currie, Mrs Edwina||Page, John (Harrow W)|
|Dicks, T.||Page, Richard (Herts SW)|
|Dorrell, Stephen||Patten, John (Oxford)|
|Dover, Denshore||Powell, William (Corby)|
|Dunn, Robert||Powley, John|
|Eggar, Tim||Prentice, Rt Hon Reg|
|Evennett, David||Proctor, K. Harvey|
|Eyre, Reginald||Raffan, Keith|
|Fallon, Michael||Rathbone, Tim|
|Finsberg, Geoffrey||Rhodes James, Robert|
|Fookes, Miss Janet||Robinson, Mark (N'port W)|
|Forth, Eric||Roe, Mrs Marion|
|Fowler, Rt Hon Norman||Rowe, Andrew|
|Fox, Marcus||Ryder, Richard|
|Franks, Cecil||Sackville, Hon Thomas|
|Garel-Jones, Tristan||Sainsbury, Hon Timothy|
|Goodlad, Alastair||St. John-Stevas, Rt Hon N.|
|Grylls, Michael||Sayeed, Jonathan|
|Hampson, Dr Keith||Shaw, Sir Michael (Scarb')|
|Harris, David||Shelton, William (Streatham)|
|Hawkins, C. (High Peak)||Shepherd, Colin (Hereford)|
|Hayward, Robert||Smith, Sir Dudley (Warwick)|
|Heddle, John||Smith, Tim (Beaconsfield)|
|Hirst, Michael||Soames, Hon Nicholas|
|Hogg, Hon Douglas (Gr'th'm)||Speed, Keith|
|Howard, Michael||Spencer, D.|
|Howarth, Alan (Stratf'd-on-A)||Spicer, Michael (S Worcs)|
|Hunt, David (Wirral)||Stanbrook, Ivor|
|Hunt, John (Ravensbourne)||Stern, Michael|
|Hurd, Rt Hon Douglas||Stevens, Lewis (Nuneaton)|
|Jackson, Robert||Stevens, Martin (Fulham)|
|Jones, Robert (W Herts)||Stewart, Andrew (Sherwood)|
|Key, Robert||Stradling Thomas, J.|
|Leigh, Edward (Gainsbor'gh)||Thomas, Rt Hon Peter|
|Lewis, Sir Kenneth (Stamf'd)||Thompson, Patrick (N'ich N)|
|Lilley, Peter||Thorne, Neil (Ilford S)|
|Lord, Michael||Thurnham, Peter|
|Luce, Richard||Townsend, Cyril D. (B'heath)|
|Lyell, Nicholas||Tracey, Richard|
|McCrindle, Robert||Twinn, Dr Ian|
|McCurley, Mrs Anna||van Straubenzee, SirW.|
|MacGregor, John||Vaughan, Dr Gerard|
|MacKay, John (Argyll & Bute)||Viggers, Peter|
|Maclean, David John.||Waddington, David|
|McNair-Wilson, M. (N'bury)||Wakeham, Rt Hon John|
|Major, John||Walden, George|
|Malins, Humfrey||Waller, Gary|
|Malone, Gerald||Wardle, C. (Bexhill)|
|Maples, John||Warren, Kenneth|
|Marlow, Antony||Watson, John|
|Mather, Carol||Watts, John|
|Maude, Francis||Wells, Bowen (Hertford)|
|Maxwell-Hyslop, Robin||Wheeler, John|
|Mayhew, Sir Patrick||Wiggin, Jerry|
|Mellor, David||Winterton, Nicholas|
|Merchant, Piers||Wolfson, Mark|
|Miller, Hal (B'grove)||Wood, Timothy|
|Mills, lain (Meriden)||Woodcock, Michael|
|Mills, Sir Peter (West Devon)||Yeo, Tim|
|Moate, Roger||Young, Sir George (Acton)|
|Morris, M. (N'hampton, S)||Tellers for the Ayes:|
|Morrison, Hon C. (Devizes)||Mr. Donald Thompson and Mr. Michael Neubert.|
|Morrison, Hon P. (Chester)|
|Moynihan, Hon C.|
|Alton, David||Bruce, Malcolm|
|Ashdown, Paddy||Carlile, Alexander (Montg'y)|
|Beith, A. J.||Cocks, Rt Hon M. (Bristol S.)|
|Bermingham, Gerald||Davis, Terry (B'ham, H'ge H'l)|
|Fields, T. (L'pool Broad Gn)||Owen, Rt Hon Dr David|
|Haynes, Frank||Parry, Robert|
|Howells, Geraint||Penhaligon, David|
|Hoyle, Douglas||Robertson, George|
|Hughes, Simon (Southwark)||Rogers, Allan|
|Jenkins, Rt Hon Roy (Hillh'd)||Ross, Stephen (Isle of Wight)|
|Johnston, Russell||Sheerman, Barry|
|Kennedy, Charles||Skinner, Dennis|
|Loyden, Edward||Steel, Rt Hon David|
|McKay, Allen (Penistone)||Stott, Rogor|
|Maclennan, Robert||Wallace, James|
|McWilliam, John||Warden, Gareth (Gower)|
|Madden, Max||Wareing, Robert|
|Marek, Dr John||Wrigglesworth, Ian|
|Mayhew, Sir Patrick|
|Meacher, Michael||Tellers for the Noes:|
|Meadowcroft, Michael||Mr. Archy Kirkwood and Mr. John Cartwright.|
§ Question acordingly agreed to.
§ Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House recognising the constraints imposed by the needs of the national economy, applauds the Government's initiative in promoting new policies for personal social services as set out in "Care in the Community" including new measures to ensure that more of the elderly, mentally ill and mentally handicapped are enabled to be cared for a: or near their own homes rather than in institutions; welcomes the Government's action in improving and extending the Joint Finance Scheme, improving co-operation between statutory services and voluntary groups and increasing financial support for the voluntary sector; and looks forward to a continuing steady improvement in the level and quality of support available to those in need in the community.